Education program (how to curry heavy things) and lumbar corsets are useless suggested by randomized controlled trial.

Hello world

I am Hiroshi Kurakata, Japanese Physiotherapist and Student of UCL.

I am going to introduce the medical literature entitled The influence of prophylactic orthoses on abdominal strength and low back injury in the workplace.

The results of the trial may change our treatment for low back pain.

This trial was designed to investigate the effect of educational program and custom molded lumbosacral orthoses for low back pain.

The subjects of this medical trial were 90 male warehouse workers randomly selected from over 800 employees at a grocery distribution center.

The subjects were divided into three groups randomly.

1. true controls, no back school (How to curry heavy products), no brace orthoses

2. back school only

3. back school plus wearing a custom molded lumbosacral orthosis 

The study team compared each of group on abdominal strength, cognitive data, work injury incidence and productivity and use of health care services at pre-testing and 6-month follow-up post-testing.

There were no significant difference between each groups in any outcomes at any point.

These results mean educational program and custom molded lumbosacral orthoses do not influence low back pain and trunk muscle strength.

Although long-term using of lumbosacral orthoses had been considered to degrade trunk muscle strength, the result rejected the hypothesis.

This trial was randomized controlled trial. However masking were not done.

Masking/blinding are the process of keeping the study group assignment hidden after allocation. They are commonly used to reduce the risk of bias in clinical trials with two or more study groups.

  

Randomized and masking/blinding play vital role to ensure reliability of clinical trial. However, as mentioned above, masking was not done in this trial. Does the fact mean we can not believe the results of this clinical trial ? I do not think so.

This is because, the placebo effect of group 2 & 3 is much bigger than that of group 1. Because group1 did not include any intervention. 

If the results of group 2 and 3 would be better than that of group 1, we need to interpret the results carefully. Even with lager placebo effect, educational program and custom molded lumbosacral orthoses did not improve outcomes compare with control (no treatment).

In conclusion, physiotherapists need to give their clients the advice that the knowledge how to curry heavy products and lumbosacral corsets are useless to control low back pain.

The conclusion which mentioned above is just my opinion, so It is not strange that other people reach other conclusion from the result of the trial.

Hiroshi Kurakata

Physiotherapist

University College London MSc Physical Therapy in Musculoskeletal Healthcare in.

Master of medical science (provided Kitasato University Graduate School)

Registered Instructor of Cardiac Rehabilitation

Certified Respiratory Therapist